Provider Demographics
NPI:1871864470
Name:ABC COUNSELING, PLLC
Entity Type:Organization
Organization Name:ABC COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC
Authorized Official - Phone:606-388-4051
Mailing Address - Street 1:978 DIEDERICH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1824
Mailing Address - Country:US
Mailing Address - Phone:606-388-4051
Mailing Address - Fax:606-388-4081
Practice Address - Street 1:678 DIEDERICH
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1824
Practice Address - Country:US
Practice Address - Phone:606-388-4051
Practice Address - Fax:606-388-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY LICENSE #1170101Y00000X
KYKY LICENSE #1040101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty